Quality of life

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* 1. Initial Data

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* 2. Initial Data

Gender

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* 3. Full Name

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* 4. Age (years)

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* 5. Mobile Phone

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* 6. Address (Street, City/Town, Postal Code, Autonomous Community, Country)

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* 7. Email Address

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* 8. Are you an MPN patient?

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* 9. Patient / Family Member of an MPN Patient


What type of Myeloproliferative Neoplasm (MPN) have you been diagnosed with?

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* 10. What genetic mutation do you have?

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* 11. Where are you being treated? (Country)

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* 12. When were you diagnosed with your MPN?

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* 13. MPN is a chronic disease with many phases and transitions. Which phase do you currently identify with?

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* 14. What symptoms or discomforts are you currently experiencing?

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* 15. FATIGUE: Of the symptoms or discomforts mentioned above, to what extent would you say it affects your quality of life?

Rate 1 Low Impact - 5. Great Impact

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* 16. BONE PAIN: Of the symptoms or discomforts mentioned above, to what extent would you say it affects your quality of life?

Rate 1 Low Impact. - 5 Great Impact

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* 17. ITCHING (PRURITUS): Of the symptoms or discomforts mentioned above, to what extent would you say it affects your quality of life?

Rate 1 Low Impact. - 5 Great Impact

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* 18. ABDOMINAL PAIN/SWELLING: Of the symptoms or discomforts mentioned above, to what extent would you say it affects your quality of life?

Rate 1 Low Impact - 5 Great Impact

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